Provider Demographics
NPI:1316459159
Name:MARTINEZ-SMITH, KATIE H (COTA/L)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:H
Last Name:MARTINEZ-SMITH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 BRIERCLIFFE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-1315
Mailing Address - Country:US
Mailing Address - Phone:774-305-0412
Mailing Address - Fax:
Practice Address - Street 1:59 SUMMER ST
Practice Address - Street 2:
Practice Address - City:REHOBOTH
Practice Address - State:MA
Practice Address - Zip Code:02769
Practice Address - Country:US
Practice Address - Phone:508-252-5814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4256224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant